基于综合肺康复管理的改良中医呼吸导引技术对南疆地区COPD稳定期患者的疗效评价

Efficacy evaluation of improved TCM respiratory guidance technology based on comprehensive pulmonary rehabilitation management in treating patients with COPD at stable stage in southern Xinjiang

目的:观察基于综合肺康复管理的改良中医呼吸导引技术对南疆地区慢性阻塞性肺疾病(COPD)稳定期患者的临床疗效。方法:选取南疆地区COPD稳定期患者100例,随机分为治疗组和对照组,每组各50例。两组患者均给予西医常规基础治疗,同时配合综合肺康复管理,对照组患者的综合肺康复管理采用缩唇腹式呼吸训练,而治疗组患者采用改良中医呼吸导引技术训练。两组患者的治疗周期均为6个月,随访周期为6个月。治疗前后,评估两组患者的主要症状积分;检测两组患者的主要肺通气功能指标,包括第1秒用力呼气容积占预计值百分比(FEV_(1)%)、第1秒用力呼气容积(FEV_(1))/用力肺活量(FVC)、最大呼气流量占正常预计值百分比(PEF%);采用COPD评估测试(CAT)评分评价患者的生活质量;采用6 min步行距离(6MWD)和Borg评分评估两组患者的运动能力及呼吸困难程度;采用汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分评价患者的心理健康状况;统计并比较两组患者在治疗1年内的急性发作住院例次、平均每次住院天数和住院总费用。结果:试验过程中,治疗组1例患者、对照组1例患者被剔除,最终治疗组49例、对照组49例纳入统计分析。(1)治疗后,两组患者的主要症状积分较治疗前均明显降低(P<0.05,P<0.01),且治疗组患者的积分低于对照组(P<0.05)。(2)治疗后,治疗组患者的FEV_(1)%、PEF%水平较治疗前升高(P<0.05),且治疗组患者的FEV_(1)%、PEF%水平高于对照组(P<0.05)。(3)治疗后,两组患者的CAT评分较治疗前均显著降低(P<0.05,P<0.01),且治疗组患者的评分低于对照组(P<0.05)。(4)治疗后,治疗组患者的6MWD较治疗前明显延长、Borg评分较治疗前显著降低(P<0.05,P<0.01),且治疗组患者的6MWD长于对照组、Borg评分低于对照组(P<0.05)。(5)治疗后,治疗组患者的HAMD、HAMA评分较治疗前均显著降低(P<0.01),对照组患者的HAMA评分较治疗前亦降低(P<0.05),且治疗组患者的HAMD、HAMA评分均低于对照组(P<0.05)。(6)在1年观察期间,与对照组患者相比,治疗组患者的急性发作住院例次明显减少、每次住院时间明显缩短、住院总费用明显降低(P<0.05,P<0.01)。结论:基于综合肺康复管理的改良中医呼吸导引技术能有效改善南疆地区COPD稳定期患者的临床症状,增强其肺功能,提高生活质量,同时减轻患者的经济负担。

Objective:To observe the clinical efficacy of improved TCM respiratory guidance technology based on comprehensive pulmonary rehabilitation management in treating patients with chronic obstructive pulmonary disease(COPD)at stable stage in southern Xinjiang.Methods:A total of 100 patients with COPD at stable stage in southern Xinjiang were selected and randomly divided into the treatment group and control group,50 cases in each group.The patients in both groups were treated with conventional western medicine,meanwhile combined with comprehensive pulmonary rehabilitation management.In comprehensive pulmonary rehabilitation management,the contracted lip-abdominal breathing training was applied for patients in the control group,and the improved TCM respiratory guidance technology training was applied for patients in the treatment group.The treatment course of both groups was 6 months,and the follow-up course was 6 months.Before and after treatment,the score of main symptoms was evaluated in both groups,and the main indexes of pulmonary ventilation function were detected,including forced expiratory volume in one second as a percentage of predicted volume(FEV_(1)%),ratio of forced expiratory volume in one second(FEV_(1))to forced vital capacity(FVC)and peak expiratory flow as a percentage of predicted volume(PEF%).The quality of life was evaluated by the score of COPD assessment test(CAT).The motor ability and the dyspnea degree were evaluated by 6-minute walking distance(6 MWD)and Borg score.The mental health was evaluated by Hamilton depression scale(HAMD)and Hamilton anxiety scale(HAMA).Within one year of intervention,the number of acute attack hospitalization,the average hospitalization days and the total hospitalization cost were calculated and compared in both groups.Results:In the course of trial,one patient in the treatment group and one patient in the control group were excluded,finally 49 cases in the treatment group and 49 cases in the control group were included for statistical analysis.(1)After treatment,the score of main symptoms in both groups was significantly decreased compared with that before treatment(P<0.05,P<0.01),and the score of the treatment group was lower than that of the control group(P<0.05).(2)After treatment,the levels of FEV_(1)%and PEF%in the treatment group were increased compared with those before treatment(P<0.05),and the levels of FEV_(1)%and PEF%in the treatment group were higher than those in the control group(P<0.05).(3)After treatment,the CAT score in both groups was significantly decreased compared with that before treatment(P<0.05,P<0.01),and the score of the treatment group was lower than that of the control group(P<0.05).(4)After treatment,the 6 MWD was significantly prolonged and the Borg score was significantly decreased in the treatment group compared with those before treatment(P<0.05,P<0.01),and the 6 MWD of the treatment group was longer than that of the control group and the Borg score was lower than that of the control group(P<0.05).(5)After treatment,the scores of HAMD and HAMA in the treatment group were significantly decreased compared with those before treatment(P<0.01),the score of HAMA in the control group was also decreased compared with that before treatment(P<0.05),and the scores of HAMD and HAMA in the treatment group were lower than those in the control group(P<0.05).(6)During the one-year observation period,compared with the control group,the number of acute attack hospitalization was significantly reduced in the treatment group,the average hospitalization days were significantly shortened,and the total hospitalization cost was significantly decreased(P<0.05,P<0.01).Conclusion:The improved TCM respiratory guidance technology based on comprehensive pulmonary rehabilitation management can effectively improve the clinical symptoms of COPD patients at stable stage in southern Xinjiang,enhance the pulmonary function,improve the quality of life,meanwhile reduce the economic burden.